Mulorz Joscha, Garcon Franziska, Arnautovic Amir, De Somer Casper, Knapsis Artis, Aubin Hug, Fleissner Felix, Rembe Julian-Dario, Vockel Malwina, Oberhuber Alexander, Lichtenberg Artur, Schelzig Hubert, Wagenhäuser Markus Udo
Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany.
Institute for Biomedical Engineering and Technology, Ghent University, 9000 Ghent, Belgium.
J Clin Med. 2023 Sep 14;12(18):5963. doi: 10.3390/jcm12185963.
The incidence of type B aortic dissection (TBAD) is increasing worldwide; however, the underlying pathomechanisms are not conclusively understood. This study explores the geometric architecture of the aortic arch and supra-aortic branches in TBAD patients as opposed to non-TBAD patients.
Patient characteristics were retrieved from archived medical records. Computer-assisted tomography (CAT) scans of patients with TBAD and carotid stenosis (CS) from two high-volume centers were analyzed. Various aortic arch parameters and take-off angles of the supra-aortic branches of TBAD patients were measured following centerline normalization in comparison CS patients. A compression index (C-index) was calculated from the para-sagittal, and a torsion index (T-index) was calculated from the para-coronal take-off angles of the supra-aortic branches to analyze aortic arch tortuosity.
A total of 199 CAT scans were analyzed, namely, 85 in the TBAD group and 114 in the CS group. The average age was 61.5 ± 13.1 years among the TBAD patients and 71 ± 9.3 years among the CS patients. We found a significantly higher proportion of type III aortic arch configurations in TBAD patients compared with CS patients. Further, the aortic arch angle was steeper in the TBAD group. In the para-sagittal plane, the left subclavian artery (LSA) take-off angle was less steep in TBAD patients. In the para-coronal plane, the left carotid artery (LCA) had a less steep take-off angle, while the LSA had a more obtuse take-off angle in the TBAD group when compared with the CS group. In addition, the inter-vessel distance was increased in TBAD patients. Finally, the T-index was increased, suggesting a significant torsion resulting from the deviating take-off angles of the supra-aortic branches supplying the left half of the body as opposed to the innominate artery (IA) in TBAD patients.
Our results suggest several aortic arch-specific geometric configurations in patients suffering from TBAD that significantly differ from those in CS patients. Further functional studies are needed to verify the pathogenetic relevance of our results and their disease-specific causality. Although our data are not mechanistically explorative, they may serve as a basis for identifying future patients with aortic arch morphology at higher risk for TBAD development and who may benefit from more stringent adjustment of risk factors as a primary prevention concept.
B型主动脉夹层（TBAD）在全球的发病率呈上升趋势；然而，其潜在的发病机制尚未完全明确。本研究旨在探究TBAD患者与非TBAD患者相比，主动脉弓及主动脉弓上分支的几何结构。
从存档的病历中获取患者特征。分析了来自两个高容量中心的TBAD患者和颈动脉狭窄（CS）患者的计算机断层扫描（CAT）图像。在中心线归一化后，测量TBAD患者的各种主动脉弓参数和主动脉弓上分支的起始角度，并与CS患者进行比较。从矢状旁位计算压缩指数（C指数），从冠状旁位计算主动脉弓上分支的起始角度的扭转指数（T指数），以分析主动脉弓的迂曲情况。
共分析了199例CAT扫描图像，其中TBAD组85例，CS组114例。TBAD患者的平均年龄为61.5±13.1岁，CS患者为71±9.3岁。我们发现，与CS患者相比，TBAD患者中III型主动脉弓构型的比例显著更高。此外，TBAD组的主动脉弓角度更陡。在矢状旁位平面上，TBAD患者的左锁骨下动脉（LSA）起始角度较平缓。在冠状旁位平面上，与CS组相比，TBAD组的左颈动脉（LCA）起始角度较平缓，而LSA的起始角度更钝。此外，TBAD患者的血管间距离增加。最后，T指数升高，表明TBAD患者中供应身体左半部分的主动脉弓上分支的起始角度与无名动脉（IA）相比存在明显扭转。
我们的结果表明，TBAD患者存在几种特定于主动脉弓的几何构型，与CS患者有显著差异。需要进一步的功能研究来验证我们结果的发病机制相关性及其疾病特异性因果关系。虽然我们的数据并非机制性探索，但它们可为识别未来具有主动脉弓形态、发生TBAD风险较高且可能从更严格调整危险因素作为一级预防概念中获益的患者提供依据。
